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Please note: Some of the tools may require registration through a third party vendor portal; and some tools may not be available for government programs at this time. Learn more. It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment. To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity's Eligibility and Benefits tool.
This free online tool can provide you with co-payment, co-insurance, deductible, and other important information. Learn More. By providing a method for online assistance with specific inquiries on finalized claims , the CIR tool can help save your staff time by reducing the need for phone calls and written correspondence.
CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization PA requests for prescription drugs that are part of the pharmacy PA program. The Dispute tool allows providers to electronically submit appeal requests for specific clinical claim denials through the Availity Portal.
The Electronic Refund Management eRM tool is designed to help simplify overpayment reconciliation and related processes. An eligibility and benefits inquiry should be completed for every patient at every visit to confirm membership, verify coverage and determine other important information, such as the patient's co-pay, co-insurance and deductible amounts.
The Availity Fee Schedule tool allows professional providers participating with BCBSTX to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform.
The Medical Record Status Viewer is an online application that allows providers to confirm receipt up to 4 of the most recent medical records submitted by mail or fax to BCBSTX for claim processing and prior authorization requests.
The Patient Care Summary tool uses claim-based information to provide you with a consolidated view of a patient's health care history at the point of care. This electronic health record can help you identify gaps in care, missed prescription refills and possible drug interactions, and other "clinical flags" and treatment opportunities. The Patient Cost Estimator is a member liability estimator tool. This free online tool can provide you with a real-time, estimated member share amount at the time of service, while the patient is still in your office, prior to claim submission.
The PEAQ program evaluates physician performance in a transparent and multidimensional way. Learn more. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
Provider Finder. Welcome Employers Producers Providers. Provider Tools. Availity Eligibility and Benefits It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment.
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